Purchase Order Psychologist in United States Miami –Free Word Template Download with AI
Professional Psychological Services Procurement Document
Issued in United States Miami, Florida
PARTIES INVOLVEDPurchasing Entity (Buyer)
Organization: Miami Behavioral Health Consortium, Inc.
Address: 3200 Biscayne Boulevard, Suite 1400, United States Miami, FL 33137
Contact: Dr. Elena Vasquez, Procurement Director
Email: [email protected]
Phone: (305) 555-0192
Tax ID (EIN): 82-4471903
Service Provider (Vendor)
Professional: Dr. Marcus A. Thornton, Ph.D., Licensed Psychologist
License No.: FL-PSY-2019-08847
Practice Address: 1850 Brickell Avenue, Floor 7, United States Miami, FL 33131
Contact: Dr. Marcus Thornton
Email: [email protected]
Phone: (305) 555-0347
Tax ID (SSN/EIN): ***-**-6721
Download and customize a professional Purchase Order Psychologist United States Miami Word template. Perfect for business, legal, and personal use. Editable and ready to boost your productivity. OF SERVICES – PSYCHOLOGIST ENGAGEMENTThis Purchase Order is issued by Miami Behavioral Health Consortium, Inc. to formally engage the services of a licensed Psychologist, Dr. Marcus A. Thornton, Ph.D., for the provision of clinical psychological evaluation, therapeutic intervention, and consultative services within the United States Miami metropolitan area. The Psychologist shall deliver all professional services in accordance with the standards established by the Florida Board of Psychology and the American Psychological Association (APA) ethical guidelines. All services rendered under this Purchase Order shall be conducted at the designated clinical facility in United States Miami or at approved off-site locations as mutually agreed upon in writing.
LINE ITEMS AND SERVICE SCHEDULE| Item # | Service Description | Quantity / Hours | Unit Rate (USD) | Extended Amount (USD) |
|---|---|---|---|---|
| 001 | Comprehensive Psychological Assessment and Diagnostic Evaluation (Psychologist-led, per client) | 45 sessions | $320.00 | $14,400.00 |
| 002 | Individual Cognitive-Behavioral Therapy (CBT) Sessions – 50 minutes each (Psychologist) | 120 sessions | $210.00 | $25,200.00 |
| 003 | Group Psychotherapy Facilitation – 90-minute sessions (Psychologist as lead clinician) | 36 sessions | $450.00 | $16,200.00 |
| 004 | Psychological Consultation and Case Management for Referring Physicians in United States Miami | 24 hours | $185.00 | $4,440.00 |
| 005 | Preparation and Delivery of Written Psychological Reports and Clinical Documentation | 45 reports | $95.00 | $4,275.00 |
| 006 | Emergency Psychological Crisis Intervention – On-call availability (Psychologist) | 12 hours | $275.00 | $3,300.00 |
| 007 | Staff Training and Psychoeducation Workshops for United States Miami Community Health Centers | 6 workshops | $1,200.00 | $7,200.00 |
| TOTAL PURCHASE ORDER VALUE: | $75,015.00 | |||
- Scope of Engagement: The Psychologist identified in this Purchase Order shall perform all clinical and consultative duties strictly within the scope of their Florida state license. Any services exceeding the licensed scope of practice must be pre-approved in writing by the Purchasing Entity.
- Payment Terms: Payment shall be made net thirty (30) days from the date of invoice submission. Invoices must reference this Purchase Order number (PO-2025-MIA-04872) and shall be submitted to the accounts payable department of Miami Behavioral Health Consortium, Inc. in United States Miami. Late payments shall accrue interest at a rate of 1.5% per month.
- Confidentiality and HIPAA Compliance: The Psychologist shall maintain strict confidentiality of all client records in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and all applicable Florida state privacy statutes. No client information shall be disclosed without proper authorization.
- Performance Standards: The Psychologist is expected to maintain a minimum session completion rate of 92% and shall provide monthly progress reports to the Procurement Director. Failure to meet performance benchmarks for two consecutive months may result in termination of this Purchase Order with thirty (30) days written notice.
- Insurance and Liability: The Psychologist shall maintain professional liability insurance with a minimum coverage of $2,000,000 per occurrence and $5,000,000 aggregate. Certificates of insurance must be provided prior to the commencement of services.
- Termination: Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, the Psychologist shall be compensated for all services rendered up to the effective date of termination.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Florida, United States. Any disputes arising from this Purchase Order shall be resolved through binding arbitration in United States Miami, Florida, in accordance with the rules of the American Arbitration Association.
- Non-Assignment: The Psychologist may not assign or subcontract any portion of the services outlined in this Purchase Order without prior written consent from the Purchasing Entity.
- Force Majeure: Neither party shall be liable for failure to perform obligations under this Purchase Order due to acts of God, natural disasters, pandemics, or other events beyond reasonable control, provided that written notice is given within five (5) business days.
Prepared By (Purchasing Entity):
Dr. Elena Vasquez, Procurement DirectorMiami Behavioral Health Consortium, Inc.
Date: _______________
Approved By (Purchasing Entity):
Robert J. Callahan, Chief Financial OfficerMiami Behavioral Health Consortium, Inc.
Date: _______________
Accepted By (Psychologist / Vendor):
Dr. Marcus A. Thornton, Ph.D.Licensed Psychologist, FL-PSY-2019-08847
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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